Individualized physiotherapy in the treatment of patellofemoral pain

Keays, Susan L., Mason, Marjon and Newcombe, Peter A. (2015) Individualized physiotherapy in the treatment of patellofemoral pain. Physiotherapy Research International, 20 1: 22-36. doi:10.1002/pri.1593

Author Keays, Susan L.
Mason, Marjon
Newcombe, Peter A.
Title Individualized physiotherapy in the treatment of patellofemoral pain
Journal name Physiotherapy Research International   Check publisher's open access policy
ISSN 1471-2865
Publication date 2015-03
Year available 2014
Sub-type Article (original research)
DOI 10.1002/pri.1593
Open Access Status
Volume 20
Issue 1
Start page 22
End page 36
Total pages 15
Place of publication Chichester, West Sussex United Kingdom
Publisher John Wiley & Sons
Collection year 2015
Formatted abstract
Background and Purpose. Patellofemoral pain (PFP) is associated with a wide range of local and global physical factors possibly contributing to pain and thus requires detailed assessment and individualized treatment. Yet, no cohort study was found that assessed the value of individualized physiotherapy, probably because this approach lends itself to clinical practice but not to scientific research. Most studies focus on a ‘knee’ or ‘hip’ treatment approach irrespective of individual global differences in lower limb alignment, movement patterns and muscle tightness. Therefore, this study aimed to determine the effectiveness of supplementing local treatment of PFP with individualized treatment targeting global contributing factors. Secondarily it aimed to subgroup the patients according to variations in lower limb alignment/laxity, movement patterns, biarticular muscle tightness and joint degeneration. Method. Forty-one patients (60 knees) with PFP who had followed a programme of local quadriceps strengthening, quadriceps stretching and taping for one fortnight were prescribed an individualized programme based on assessment. This global assessment included lower limb postural alignment, movement patterns, muscle tightness and range of motion. Another fortnights treatment was prescribed accordingly and included specific, individualized postural and movement retraining, stretching and functional weight-bearing, strengthening exercises. Seven outcome measures, namely four pain measures, isokinetic quadriceps strength, quadriceps length and eccentric knee control, assessed improvement. Results. All outcome measures showed further significant improvement following individualized treatment (p < 0.03). Patients fell into four broad physical subgroups: hypermobility (often with malalignment), hypomobility (with three of four tight muscle groups), faulty movement patterns (mostly dynamic knee valgus) and patellofemoral osteoarthritis. Conclusions. Individualized treatment supplementing local standard physiotherapy for PFP leads to further significant improvement over 2 weeks. This study highlights the importance of assessing patients globally in order to optimize treatment and ongoing improvement. Recognition of different subgroups may guide treatment that should include both local and deficit-targeted global treatment.
Keyword Faulty movement patterns
Individualized treatment
Lower limb alignment
Patellofemoral osteoarthritis
Patellofemoral pain
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published online ahead of print 22 May 2014

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Nursing, Midwifery and Social Work Publications
School of Psychology Publications
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